Yamada H, Takamori K. Status of plasmapheresis for the treatment of toxic epidermal necrolysis in Japan. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. Paradisi A, et al. Drug induced exfoliative dermatitis: state of the art. Other dermatoses associated with erythroderma are listed in Table 1.2,3,68. Exfoliative dermatitis is a rare inflammatory skin condition that is characterized by desquamation and erythema involving more than 90% of the body surface area. 2012;12(4):37682. Association between HLA-B* 1502 allele and antiepileptic drug-induced cutaneous reactions in Han Chinese. Cutaneous graft-versus-host diseaseclinical considerations and management. Int J Dermatol. However, patchy, diffuse areas of postinflammatory hyperpigmentation and hypopigmentation may occur, especially in patients with darker skin.1,4 One case of posterythrodermic generalized vitiligo beginning six weeks after the onset of exfoliative dermatitis has been reported.29,30 Residual eruptive nevi and keloid formation are rare sequelae. Archivio Istituzionale della Ricerca Unimi, Nayak S, Acharjya B. For the prevention of deep venous thrombosis; usually low molecular weight heparin at prophylactic dose are used. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Arch Dermatol. McCormack M, et al. 2008;159(4):9814. Drug-induced LPP. Fernando SL. Karnes JH, Miller MA, White KD, Konvinse KC, Pavlos RK, Redwood AJ, Peter JG, Lehloenya R, Mallal SA, Phillips EJ. 2010;85(2):131138. Google Scholar. 2015;64(3):2779. Drug eruptions that initially present as morbilliform, lichenoid or urticarial rashes may progress to generalized exfoliative dermatitis. HLA DQB1* 0301 allele is involved in the susceptibility to erythema multiforme. Etanercept: monoclonal antibody against the TNF- receptor. Gastrointest Endosc. Wolkenstein P, et al. Recurrent erythema multiforme: clinical characteristics, etiologic associations, and treatment in a series of 48 patients at Mayo Clinic, 2000 to 2007. These molecules may play a role in amplifying the immune response and in increasing the release of other toxic metabolites from inflammatory cells [48]. Article Erythema multiforme StevensJohnson syndrome and toxic epidermal necrolysis. 2022 May;35(5):e15416. Joint Bone Spine. Fas-FasL interaction: Fas is a membrane-bound protein that after interaction with Fas-ligand (FasL) induces a programmed cell death, through the activation of intracellular caspases. 2005;136(3):20516. Because a certain degree of cross-reactivity between the various aromatic anti-epileptic drugs exists, some HLAs have been found to be related to SJS/TEN with two drugs, as the case of HLA-B*1502 with both phenytoin and oxcarbazepine [32]. It is advised against the use of silver sulfadiazine because sulphonamide can be culprit agents. Patients with carcinoma of the colon, lung, prostate and thyroid have presented with erythroderma. Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment. 2016 Nov 15;17(11):1890. doi: 10.3390/ijms17111890. In acute phase it is crucial to assess the culprit agent, in particular when the patient was assuming several drugs at time of DHR. Drug induced exfoliative dermatitis (ED) are a group of rare and severe drug hypersensitivity reactions (DHR) involving skin and usually occurring from days to several weeks after drug exposure. In recent years, clinicians have come to believe that this condition is secondary to a complicated interaction of cytokines and cellular adhesion molecules. Erythema multiforme and latent herpes simplex infection. If there is a high suspicion of infection without a documented source of infection, broad range empiric therapy should be started. Huff JC. loss of taste Derm: stevens-johnson syndrome, toxic epidermal necrolysis, rash, exfoliative dermatitis, hair . Sequelae of exfoliative dermatitis are not widely reported. The exact role of FasL in the pathogenesis of toxic epidermal necrolysis is still questionable especially because a correlation between serum FasL levels and disease severity has not been established and because its levels have been found to be increased also in drug-induced hypersensitivity syndrome and maculopapular eruption [36]. Skin manifestations of drug allergy. A patch testing and cross-sensitivity study of carbamazepine-induced severe cutaneous adverse drug reactions. Szary syndrome, the leukemic variant of mycosis fungoides, is also associated with exfoliative dermatitis. Interstitial nephritis is common in DRESS syndrome, occurring roughly in 40% of cases, whereas pre-renal azotemia may occur in SJS and TEN. Scientific evidences suggest a role for HLAs and drug-induced SJS/TEN, although some racial differences have been found that can be due to variation of frequencies of these alleles and to the presence of other susceptibility genes [26]. Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS. Br J Dermatol. 1984;101(1):4850. Kirchhof MG et al. In vitro diagnostic assays are effective during the acute phase of delayed-type drug hypersensitivity reactions. A rare case of toxic epidermal necrolysis with unexpected Fever resulting from dengue virus. Before Several authors report the incidence of hospitalization for EM ranging from 0.46 cases per million people per year of northern Europe [11] to almost 40 cases per million people per year of United States [12]. Copyright 2023 American Academy of Family Physicians. Schopf E, et al. J Allergy Clin Immunol. The diagnosis of GVDH requires histological confirmation [87]. Kamaliah MD, et al. Possible involvement of CD14+CD16+monocyte lineage cells in the epidermal damage of StevensJohnson syndrome and toxic epidermal necrolysis. On the other hand, it has been demonstrated that genetic predisposition may increase the risk for sulphonamide-induced [24] and carbamazepine-induced TEN and SJS [25]. Abe R, et al. (See paras 3 - 42 and 3- 43.) A catabolic state thus ensues, which is often responsible for significant weight loss. Utility of the lymphocyte transformation test in the diagnosis of drug sensitivity: dependence on its timing and the type of drug eruption. Erythroderma is an intense and widespread reddening of the skin due to inflammation which may often be associated with peeling of skin termed as exfoliative dermatitis. All Rights Reserved. Furosemide or ethacrynic acid may be required to maintain an adequate urinary output [90]. Downey A, et al. official website and that any information you provide is encrypted The average age at onset is 55 years, although exfoliative dermatitis may occur at any time.2, Exfoliative dermatitis is the result of a dramatic increase in the epidermal turnover rate. Although the final result of this dual interaction is still under investigation, it seems that the combination of TNF-, IFN- (also present in TEN patients) and the activation of other death receptors such as TWEAK can lead to apoptosis of keratinocytes [44]. 1995;333(24):16007. 2012;167(2):42432. Burns. A multidisciplinary team is fundamental in the therapeutic management of patients affected by exfoliative DHR. HLA-B* 5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Loss of normal vasoconstrictive function in the dermis, decreased sensitivity to the shivering reflex and extra cooling that comes from evaporation of the fluids leaking out of the weeping skin lesions all result in thermoregulatory dysfunction that can cause hypothermia or hyperthermia.6 The basal metabolic rate also is increased in patients with exfoliative dermatitis. Nat Med. Epidemiological studies on EM, SJS and TEN syndromes report different results, probably related to several biases, such as ethnical differences, diagnostic criteria and drug consumption patterns in different socio-economic systems. Erythema multiforme. Overall, T cells are the central player of these immune-mediated drug reactions. . Pathophysiology DIP. HHS Vulnerability Disclosure, Help Erythema multiforme and toxic epidermal necrolysis. Kano Y, et al. Expression of alpha-defensin 1-3 in T cells from severe cutaneous drug-induced hypersensitivity reactions. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. In postmarketing reports, cases of drug-induced hepatotoxicity have been reported in the first month, and in some cases, the first 2 months of NSAID therapy. Fitzpatricks dermatology in general medicine. Stern RS. 1998;37(7):5203. Chem Immunol Allergy. Cite this article. Many people have had success using a dilute vinegar bath rather than a bleach bath. Locharernkul C, et al. Ibuprofen Zentiva can be prescribed with OTC Recipe - self-medication. 2008;12(5):3559. Exfoliative Dermatitis is a serious skin cell disorder that requires early diagnosis and treatment. Iv bolus of steroid (dexamethasone 100300mg/day or methylprednisolone 2501000mg/day) for 3 consecutive days with a gradual taper steroid therapy is sometimes advised. 1997;19(2):12732. Tang YH, et al. Gynecologist consultation is required for avoiding the appearance of vaginal phimosis or sinechias. 2013;27(3):35664. Chung WH, Hung SI. Exfoliative dermatitis is a dangerous form of CADR which needs immediate withdrawl of all the four drugs. Semin Dermatol. Ann Intern Med. Plasmapheresis may have a role in the treatment of ED because it removes Fas-L [96], other cytokines known to be implied in the pathogenesis (IL-6, IL-8, TNF-) [97, 98]. A central role in the pathogenesis of ED is played by CD8+ lymphocytes and NK cells. The authors wish to thank Dr. Gary White for the picture of EM showed in Fig. Gout and its comorbidities: implications for therapy. Drug-induced exfoliative dermatitis is usually short-lived once the inciting medication is withdrawn and appropriate therapy is administered. Nutr Clin Pract. Chung WH, et al. Sokumbi O, Wetter DA. In: Eisen AZ, Wolff K, editors. Mayo Clin Proc. Article New York: McGraw-Hill; 2003. p. 54357. Clinical and Molecular Allergy erythroderma, exfoliative dermatitis, and fixed drug reactions) 4, 5 and . PubMedGoogle Scholar. For these reasons, patients should be admitted to intensive burn care units or in semi-intensive care units where they may have access to sterile rooms and to dedicated medical personnel [49, 88]. Open trial of ciclosporin treatment for StevensJohnson syndrome and toxic epidermal necrolysis. Previous vol/issue. 1997;22(3):1467. The administration of a single dose of 5mg/kg was able to stop disease progression in 24h and to induce a complete remission in 614days. Patients with underlying skin disorders may respond much more slowly to therapy, but clearing almost always occurs eventually.
drug induced exfoliative dermatitis
